Healthcare Quality and Patient Outcomes

Quality Improvement Basics

• Quality improvement is a structured process to improve healthcare, aiming to meet or exceed expectations.
• To Err Is Human (Kohn, Corrigan, & Donaldson, 2000) found that medical errors cause between 44,000 and 98,000 deaths annually.
• Crossing the Quality Chasm (Institute of Medicine, 2001) identified goals for improving the US healthcare system's performance.
• The first section defines quality, its importance in healthcare, and key figures in quality improvement.
• The second section outlines a strategic framework for improving quality, based on the Baldrige Award criteria.
• The third section discusses common quality improvement elements.
• The fourth and fifth sections cover quality improvement approaches and techniques, including tools.
• The Institute of Medicine defines quality health services as those that increase the likelihood of desired health outcomes and conform to professional knowledge.
• High-quality services target individual preferences regarding variety and achieve health outcomes consistent with societal preferences for efficiency.
• They adhere to professional standards and scientific evidence, aligning with healthcare provider preferences.
• Donabedian's quality concepts include structure (material & human resources), process (actual delivery of care), and outcomes (results of care).
• Donabedian's four parts also include technical management of health and illness, interpersonal relationships between providers and clients, amenities of care for patient interest, and ethical principles guiding care.
• Quality is characterized by effectiveness (doing the right things) and efficiency (doing things right).
• Effectiveness means providing services based on science to those who benefit, and not to those unlikely to benefit.
• Efficiency implies avoiding waste, including equipment, supplies, ideas, and energy resources.
• Underuse refers to failing to provide a service whose benefits outweigh risks. Overuse refers to providing a service when its risks exceed benefits.
• Misuse involves providing a service badly, diminishing its benefit to the patient, and medical errors are a key aspect of misuse.
• The appropriate use of resources is critical in healthcare quality, aiming to improve the health of individuals throughout the population.
• One of quality's key issues is the appropriate use of these resources.
• Factors causing medical overuse include prescribing antibiotics for children's ear infections despite their typically self-resolving nature.
• Health informatics involves using information technology to enhance healthcare quality, efficiency, and cost-effectiveness.
• Health analytics uses data to support fact-based decision making.
• Data mining uses sophisticated tools for understanding and predicting health outcomes.
• Common quality improvement elements include measurement (definition, reliability, and validity), process variation (special and common cause variation), and statistical process control.
• Measurement definition defines the intended measurements (e.g., wait times).
• Reliability means the measures are consistent over time and among different individuals.
• Validity ensures the measures are accurate.
• Special cause variation arises from unusual or infrequent unique events.
• Common cause variation is due to usual or natural process causes.
• Statistical process control is used to track and manage process variation.
• Continuous process improvement (CQI) is a structured organizational process. Its five dimensions are process focus, customer focus, data-based decision making, employee empowerment, and organization-wide scope.
• The FOCUS/PDCA cycle comprises: Find the problem, Organize a team, Clarify the problem, Understand the issue, Select improvements, Plan how to implement, Do it, Check the result, and Act on the outcome.
• Six Sigma aims to remove variation from processes. Resources needed include upfront training in quality improvement tools and methods. High-quality training and leaders are important.
• DMAIC stands for Define, Measure, Analyze, Improve, and Control. DMAIC is a set of steps to ensure and improve quality in a healthcare setting.
• Toyota Production System/Lean emphasizes value creation, eliminating waste (overproduction, inventories, transportation, defects, waiting, and underutilization of staff), continuous improvement, unification of purpose, respect for workers, visualization, and flexible systems.
• Effective quality improvement uses tools like process mapping, flowcharts, workflow diagrams, check sheets, chart abstractions, cause-and-effect diagrams, and Pareto charts.

EHR and EMR

• Assignment questions regarding EHR and EMR detail need further context, which this document doesn't provide.

Explore the crucial concepts of healthcare quality and management through this quiz. Learn about medical errors, Donabedian's model, and the challenges of service underuse and overuse. Test your understanding of how quality in healthcare aligns with patient preferences and outcomes.